RET/PTC Rearrangements Are Associated with Elevated Postoperative TSH Levels and Multifocal Lesions in Papillary Thyroid Cancer without Concomitant Thyroid Benign Disease

PLoS One. 2016 Nov 1;11(11):e0165596. doi: 10.1371/journal.pone.0165596. eCollection 2016.

Abstract

RET/PTC rearrangements, resulting in aberrant activity of the RET protein tyrosine kinase receptor, occur exclusively in papillary thyroid cancer (PTC). In this study, we examined the association between RET/PTC rearrangements and thyroid hormone homeostasis, and explored whether concomitant diseases such as nodular goiter and Hashimoto's thyroiditis influenced this association. A total of 114 patients diagnosed with PTC were enrolled in this study. Thyroid hormone levels, clinicopathological parameters and lifestyle were obtained through medical records and surgical pathology reports. RET/PTC rearrangements were detected using TaqMan RT-PCR and validated by direct sequencing. No RET/PTC rearrangements were detected in benign thyroid tissues. RET/PTC rearrangements were detected in 23.68% (27/114) of PTC tissues. No association between thyroid function, clinicopathological parameters and lifestyle was observed either in total thyroid cancer patients or the subgroup of patients with concomitant disease. In the subgroup of PTC patients without concomitant disease, RET/PTC rearrangement was associated with multifocal cancer (P = 0.018). RET/PTC rearrangement was also correlated with higher TSH levels at one month post-surgery (P = 0.037). Based on likelihood-ratio regression analysis, the RET/PTC-positive PTC cases showed an increased risk of multifocal cancers in the thyroid gland (OR = 5.57, 95% CI, 1.39-22.33). Our findings suggest that concomitant diseases such as nodular goiter and Hashimoto's thyroiditis in PTC may be a confounding factor when examining the effects of RET/PTC rearrangements. Excluding the potential effect of this confounding factor showed that RET/PTC may confer an increased risk for the development of multifocal cancers in the thyroid gland. Aberrantly increased post-operative levels of TSH were also associated with RET/PTC rearrangement. Together, our data provides useful information for the treatment of papillary thyroid cancer.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Carcinoma / blood
  • Carcinoma / genetics*
  • Carcinoma / pathology*
  • Carcinoma / surgery
  • Carcinoma, Papillary
  • Female
  • Gene Rearrangement*
  • Goiter, Nodular / complications
  • Hashimoto Disease / complications
  • Humans
  • Life Style
  • Male
  • Middle Aged
  • Postoperative Period
  • Proto-Oncogene Proteins c-ret / genetics*
  • Thyroid Cancer, Papillary
  • Thyroid Gland / pathology*
  • Thyroid Gland / surgery
  • Thyroid Neoplasms / blood
  • Thyroid Neoplasms / genetics*
  • Thyroid Neoplasms / pathology*
  • Thyroid Neoplasms / surgery
  • Thyrotropin / blood*
  • Young Adult

Substances

  • Thyrotropin
  • Proto-Oncogene Proteins c-ret

Grants and funding

This work is supported by grants from the National Natural Science Foundation of China [grant numbers 81272955 and 81602426]; the Medical Science and Technology Research Fund Project of Guangdong Province [grant number A2015003]; and Natural Science Foundation of Guangdong Province [grant number 2016A030310198]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.